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Hormone Replacement- Saves Lives!

Posted on November 29, 2013 by Dan Lee | Posted in Bioidentical Hormone Replacement Therapy

I see numerous women every week for evaluation of symptoms because of hormone deficiency.  These include hot flashes, mood changes, low libido, recurrent UTI’s, vaginal dryness, and many others.  These women are relieved to hear they are not “crazy” and that there is something that can be done for their symptoms.

Unfortunately often they have been told by another physician that there is nothing they can do about their symptoms.  In fact, a patient last week said that her previous doctor told her the only thing she could do for her hot flashes was to take a cold shower every time she felt them.  She laughed as she said, “then I would need to spend the entire day and night in the shower .”  So why did her doctor tell her this? Why are so many women not being treated for their hormone related symptoms?

In the 1990s, more than 90% of hysterectomized women in their 50s used estrogen therapy (ET). Following the initial publication of findings from the estrogen/progestin therapy Women’s Health Initiative (WHI) clinical trial in 2002, the use of hormone therapy declined substantially. Currently, some 30% of women post-hysterectomy use ET.  Thus the WHI study casted a tremendous amount of fear about hormones, leading to a 60% drop in hormone replacement.

However further analysis has been overlooked by many physicians who do not keep up to date with the current literature.  When in fact the ET-alone Women’s Health Initiative trial found that among women aged 50-59 years, ET reduces mortality compared with placebo. Although most of this reduction in mortality was the result of fewer deaths from coronary heart disease, declines in breast cancer mortality were also observed.[1,2]

In a recent issue of the American Journal of Public Health,[3] investigators calculated the excess mortality among US women aged 50-59 years as a consequence of not using  ET during the decade from 2002 through 2011. Estimates of excess premature mortality attributed to nonuse of ET in this population for these 10 years ranged from 9,000 to 92,000 women.

ET, like all medications, has risks as well as benefits. For instance, oral estrogen increases the risk for venous thrombosis (blood clots) as well as stroke.[4]  This however is why I only use transdermal estrogen, because it does not increase the risk of blood clots or strokes.

However, the current overblown fears result in avoidance of hormone therapy, leading many appropriate candidates to miss out on the symptom relief, prevention of osteoporosis, and treatment of symptomatic genital atrophy that hormone therapy can offer. This provocative report appropriately points out that wholesale avoidance of hormone therapy can also have important negative public health consequences.

So if you are having symptoms related to hormone deficiency then see a physician who treats women on a daily basis for hormonal related symptoms.  One who does not think you are crazy and won’t tell you to jump in the shower!

1. LaCroix AZ, Chlebowski RT, Manson JE, et al; WHI Investigators. Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy: a randomized controlled trial. JAMA. 2011;305:1305-1314.

2. Anderson GL, Chlebowski RI, Aragaki AK, et al. Conjugated equine estrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women’s Health Initiative randomised placebo-controlled trial. Lancet Oncol. 2012;13:476-486.

3. Sarrel PM, Njike VY, Vinante V, Katz DL. The mortality toll of estrogen avoidance: an analysis of excess deaths among hysterectomized women aged 50 to 59 years. Am J Public Health. 2013 Jul 18.

4. North American Menopause Society. The 2012 hormone therapy position statement of the North American Menopause Society. Menopause. 2012;19:257-271.

 

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